Transcript Document

Equine Facilitated Mental Health
for Veterans with
Posttraumatic Stress Disorder
Participant Hand-Outs
Jennifer Tevlin, MS, LAC, NCC, Director of Special Programs
Jackie West, Head Instructor
Sunnyside Equestrian Center, Lincroft, NJ
PATH Region 1 Conference
April 17-19, 2015
What is Posttraumatic Stress Disorder?
• Posttraumatic Stress Disorder = PTSD
• May occur at any age
• Directly experience, witness or learn of traumatic event
• PTSD must be correctly diagnosed by licensed mental health
professional
In general, what are the symptoms of PTSD?
• Psychological and Physiological reactions
• Cognitive Effects (often co-occurs w/traumatic brain
injury (TBI) in veterans)
• Memories of traumatic event
• Nightmares
• Flashbacks & Re-experiencing
• Avoidance
In general, what are the symptoms of PTSD?
• Detachment, hopelessness
• May include anxious and depressed symptoms
• Negative thoughts & feelings, guilt, shame
• Irritability, anger
• Hyperarousal
• Problems with concentration and sleep
What Treatments are Currently used to help
Veterans with PTSD?
• Eye Movement Desensitization and Reprocessing (EMDR)
• Cognitive Behavioral Therapy (CBT)
o Prolonged Exposure (PE) Therapy
o Cognitive Processing Therapy (CPT)
• Medications: Anti-anxiety, anti-depressants, Prazosin
What are Equine-Assisted Activities and Therapies?
• Equine-Assisted Activities and Therapies = EAAT
• EAAT MAY Include:
o Therapeutic horseback riding
o Equine-Facilitated Mental Health (EFMH)
o Equine-Facilitated Learning (EFL)
• EAAT is Team Approach Involving:
o A horse or horses as therapeutic partners
o A participant (may be a client, patient or student)
o MAY Include (depending on type of EAAT): Licensed Mental Health
Professional, Educator, Therapeutic Riding Instructor, Certified EquineSpecialist in Mental Health & Learning (ESMHL)
How are Equine-Assisted Activities and Therapies
Different than Currently Accepted Treatments?
• In General, EAAT:
Is Dynamic
May be less threatening
Works with horse as partner
May be passive or active depending on type of EAAT
Allows participant to experiment with new behaviors and
receive immediate feedback from horse(s)
o Allows participant to explore relationships in nonjudgmental setting
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What is Equine-Facilitated Mental Health?
• Equine-Facilitated Mental Health (EFMH):
o Is a team-approach to therapy, involving:
A horse or horses as therapeutic partners
A Client or group of Clients
A Mental Health Professional
A certified Equine-Specialist in Mental Health & Learning
(ESMHL)
o Is Experiential
o Uses Metaphors
o Is an adjunct to traditional therapies
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What are Some Reasons a Veteran May Seek
EFMH for PTSD?
• Other types of therapy have not been effective in helping
some or all of the veteran’s symptoms
• Veteran may have a love of, or interest in, animals, including
horses
• Veteran may relate to horse as respected symbol of power
• EFMH may not “feel” like therapy
• Team approach may be appealing
• Veteran recognizes physical and mental health benefits of
interacting with horses, being outdoors, and moving around
What are Some of the Benefits of EFMH for
a Veteran with PTSD?
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Oxytocin release as a result of petting and grooming a horse
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Immediate biofeedback
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Safe, unconditionally accepting relationships with horses
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Mindfulness of present moment
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Fun & interesting work learning new skills, learning & understanding horse
psychology & behavior
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Grounding techniques involving horses
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Metaphorical and experiential activities, applicable to real-world scenarios
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Awareness of mind-body connection, breathing, energy, body movement, position
What are Some of the Benefits of EFMH for
a Veteran with PTSD?
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Additional support through team approach
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Opportunity for powerful emotional release
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Share feelings while actively petting, grooming, walking w/horse
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Sense of normalcy (especially if veteran has positive childhood, or
other past experiences with animals)
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Awakening of happy feelings through laughter, smiling at horse
behavior/interactions
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May provide a purpose: Ability to help horse through
rehabilitation or training
Some Things to Consider When Working with
Veterans who have PTSD in an EFMH Setting
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Military branches have individual and shared aspects of culture
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Educate yourself about military culture
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Use your judgment to understand unfamiliar military terms “in the
moment” or research after session
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May be difficult for veteran to ask for and accept help
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PTSD does not have same visible wounds as many physical
injuries, making it difficult for veteran to understand that they
deserve help
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Stigma associated with mental health in the military
Some Things to Consider When Working with
Veterans who have PTSD in an EFMH Setting
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Respect veteran’s right to privacy and confidentiality as you would with
any client
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During intake assessment, provide tour of facility: Point out safe, private,
quiet places where veteran can go if they need to take a break
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Hold EFMH sessions during low volume, off-peak, quiet times
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Ask veteran to identify potential triggers: Always be aware when there
may be planes, gun shots or other sights, sounds or smells that could
trigger a flashback or create a stressful situation for the veteran, and
have a plan to manage any symptoms that may arise
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Struggling to find new identity, especially when no longer able to work in
military or another former career due to PTSD
Some Things to Consider When Working with
Veterans who have PTSD in an EFMH Setting
• Veterans often relate well to horse’s position as prey
animal in nature
• Psychology of horse as a prey animal is similar to
psychology of veteran in dangerous situation: Both have
heightened awareness, use peripheral vision to
constantly scan environment for threats, and rely on
quick assessments of situations to determine danger
• Consider structuring program so veteran has opportunity
to volunteer at farm
What are Some EFMH Techniques for a
Veteran with PTSD?
• Herd Observation
• Choose equine partner from herd and process decision
• Groom, pet, lead equine partner: Focus on mindfulness
including energy, breathing, body position and
movement, as well as horse’s reaction when adjustments
are made
• Design an obstacle course representing most significant
challenges or future goals and walk through it with
equine partner
What are Some EFMH Techniques for a
Veteran with PTSD?
• Grounding techniques using concrete objects or images
such as piece of horse mane or tail, or picture of horse
• Doubling exercise with horse as supportive figure
• Chalk exercises with horses: Feelings, Characteristics,
Qualities, Goals
• Identify events or feelings and physically move them by
leading horse to new destination
What are Some EFMH Techniques for a
Veteran with PTSD?
• Metaphors around significant life elements involving
feed buckets and horses to represent positive and
negative influences
• Concrete activities using obstacle courses to focus on
real life problems like time management, prioritizing
tasks, daily, short term and long term goals and
relationships
• Teach horse to back or lounge
• Teach horse to accept tack or equipment
What are Some EFMH Techniques for a
Veteran with PTSD?
• Create areas of the arena to represent current
struggles or achievements, and observe where
veteran stands and where horse or horses stand
and process significance
• Teach horse behavior and psychology during
session and continually process equine responses to
veteran’s speech, tone, pace, volume, body
language, body position, and movement
What are Some EFMH Techniques for a
Veteran with PTSD?
• Use a horse with a visible physical injury such as a missing eye,
an injury that you cannot see but which restricts the horse’s
ability to perform his job, such as laminitis, or a horse who has
himself, experienced some type of past trauma, which causes
him to be even more cautious, vigilant and apprehensive
• Consider sharing some of this information with the veteran, or
allow the veteran to tell you what he or she believes
happened to the horse, as well as what the horse is thinking
and feeling, and what the horse needs to progress and heal
• Consider asking the veteran if he or she sees any parallels
between the horse’s journey and their own journey
During an EFMH Session with a Veteran
Remember to…
• Help veteran identify, express and process emotions
including anger, guilt, shame, sadness and fear
• Provide support and reflect back feelings
• Normalize PTSD as the result of heroic military service
• Validate decision to get help
• Incorporate future-focused goals
• Assign relevant homework to aid healing in between
sessions
Thank you!